Application Form

for

World Port Picture Exhibition and Contest

The following should be typed.

ADDRESS	NAME OF COUNTRY:
	ADDRESS:
	PHONE NUMBER:
	FAX NUMBER:
	e-mail address:
NAME	, Last name First name Middle name
AGE	( ) YEARS OLD		SEX	MALE FEMALE (CIRCLE EITHER ONE)
NAME OF YOUR SCHOOL OR OCCUPATION					( ) GRADE
NAME OF YOUR PICTURE
METHOD OF DELIVERY	CLICK EITHER ONE ¨ I WILL SUBMIT MY PICTURE DIRECTLY (SUBMIT DELIVERY OF THE PICTURE) ¨ I WILL SUBMIT MY PICTURE BY MAIL
METHOD OF REMOVAL		CLICK ONE ¨ I WILL PERSONALLY REMOVE THE PICTURE. ¨ PLEASE HAVE MY PICTURE SENT TO ME BY THE Nagoya International Removal and Fine Arts Office. ¨ PLEASE DISCARD MY PICTURE.

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